Health inspection·February 19, 2025

F 0675 decisions. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 3 ' s MDS dated [DATE], the MDS indicated the Resident 3 has intact cognition. Residents Affected - Some During a resident room observation and interview on 2/14/2025 at 1:50PM, the room was observed with paint bubbling on the ceiling in multiple areas around bed C in Resident 1 ' s room. Resident 1 stated on Thursday 2/13/2025 at around 10AM there was water leaking from the ceiling onto her roommate's bed and the floor. Resident 1 stated her roommate was not in her room for several hours because water was leaking on top of her bed. Resident 1 stated the staff removed all the soaked linens then placed a big plastic bag over her roommate ' s bed and then placed a bucket below the ceiling to collect the water. Resident 1 stated that her roommate returned to the room at 8:30pm when the ceiling stopped leaking water. Resident 1 stated she was in her room in bed the entire day and that the rain did not affect her bed area, but it did cause her anxiety because the amount of water leaking was so much made her worried about her own safety. During an observation in Resident 2 ' s room on 2/14/2025 at 2PM, the room was observed with paint bubbling around the ceiling light above bed B with light green discoloration around the ceiling light fixture. During an observation in the activity room on 2/14/2025 at 2:10PM, the room was observed above the entrance to the administrative office on the ceiling with paint bubbling around an electrical outlet. During an interview on 2/14/2025 at 2:15PM, Resident 2 stated that on 2/13/2025, water started leaking late morning around 11AM and water was leaking at the foot of bed B. Resident 2 stated the leak was a steady and constant drip of water. Resident 2 stated the staff soaked up the big puddle of water with bed linens and towels. Resident 2 stated when she walked back to her room around 12pm, she saw another leak over bed B. Resident 2 stated while in the activity at around 2PM the activity room was leaking water in 4 areas. There was one area water leak on the ceiling into a bucket by the entrance to the administration office and the 3 other areas located in the back end of the activity room by the window facing the street. Resident 2 stated there was water leaking from the window above the exit sign and the water was pooling onto the floor. Resident 2 stated the staff placed a lot of towels on the floor to soak up all the pooling water. Resident 2 stated water was entering in between the windows above the ceiling and there was water leaking from two light fixtures into a bucket at a constant rate. Resident 2 stated the dripping made her anxious and was worried the ceiling would collapse in the activity room and in her room. Resident 2 stated that her and her roommate returned to the room at around 8PM when the water leaking stopped. Resident 2 stated she still felt anxious because she was afraid the ceiling would collapse from the all the rain damage. During an interview on 2/14/2025 at 2:55PM, the Activity Assistant (AA) stated on 2/13/2025 at around 2PM there was water entering from the window above the exit sign and water pooling onto the floor. The AA stated he placed a lot of towels on the floor to soak up the water. The AA stated the water was entering in between the windows and above were two light fixtures. Just below the light fixtures were leaking water into a bucket. The AA stated that the ceiling by the entrance to the administration office water was leaking into a bucket and that there was a leak around an unused electrical outlet. The AA stated the paint on the ceiling around the electrical outlet had a large bubble area where the paint was bulging from the water leak. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555839 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dreier's Nursing Care Center 1400 West Glenoaks Blvd Glendale, CA 91201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0675 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 2/14/2025 at 3:20PM, Resident 3 stated she was scared when the rain started at the foot of her bed and that the water started pooling on 2/13/2025 at around 12PM causing her to feel anxious. Resident 3 stated the staff placed linens and towels to soak up the water. Resident 3 stated the staff had to change the linens and towels 3 to 4 times because the water kept leaking. Resident 3 stated her bed had a plastic tarp and bucket that was placed on top of the bed to collect the water that was constantly leaking, and the bucket was emptied several times. Resident 3 stated she in the hallway waiting for the rain to stop. Resident 3 stated she returned to her room late at night around 8PM but was worried the ceiling would leak over her bed. During an interview on 2/14/2025 at 3:30PM, the Maintenance Supervisor (MS) stated when he came in to work on 2/14/2025 he started putting a plastic tarp on the entire roof of the facility. The MS stated he did not have time to look in the resident rooms because the kitchen ceiling had a lot of damage. The MS stated he saw the water damage in the activity room above the entrance to the administration office. The MS stated the water damage was around and electrical outlet in an inactive ceiling light which did pose as a potential hazard for residents. During a review of the facility ' s P&P titled Safety and Supervision of Residents revised 7/2017, indicated the facility strives to make the environment as free from accident hazards as possible and resident safety and supervision and assistance to prevent accidents are facility-wide priorities. The policy indicated resident supervision is a core component of the systems approach to safety. The type and frequency of resident supervision is determined by the individual resident's assessed needs and identified hazards in the environment. The policy indicated due to their complexity and scope, certain resident risk factors and environmental hazards are addressed in dedicated policies and procedures, these risk factors and environmental hazards include the following: bed safety and electrical safety. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555839 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dreier's Nursing Care Center 1400 West Glenoaks Blvd Glendale, CA 91201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and record review, the facility failed to maintain a safe environment in two of two resident ' s rooms (Residents 1 and 2), residents ' shared bathroom, facility kitchen, and resident ' s activity room. This had the potential for residents to be placed at risk for injury. Findings: During an observation on 2/14/2025 at 10:43 AM in facility parking lot, plastic tarp cover was observed in various parts of the roof of the facility. During an interview on 2/14/2025 at 10:49 AM with the director of nursing (DON), the DON stated she does not know if there is a water leak in the facility. During an observation on 2/14/2025 at 10:51 AM in Resident 2 room bed B, the room was observed with paint bubbling around ceiling above bed B with discoloration. During an interview on 2/14/2025 at 10:55 AM with Resident 2, Resident 2 stated on 2/13/2025 around 11 AM, water started leaking at the foot of bed B. Resident 2 stated the leak was a steady constant drip of water. Resident 2stated the staff soaked up the big puddle of water with bed linens and towels. Resident 2 stated when she walked back to her room around 12pm, she observed another water leak was over bed B. Resident 2 stated she returned back to activity room. Resident 2 stated while in the activity at around 2 PM the activity room, there was water leaking from the ceiling by the entrance to the administration office. Resident 2 stated there was also water leaking from the ceiling of the resident shared bathroom. During an observation on 2/14/2025 at 11:12 AM in the facility kitchen, the kitchen was observed with paint bubbling and cracking around the ceiling. The damaged ceiling is directly over the mechanical washing area (Dish machine area and three compartment sink for pots and pans washing). During an interview on 2/14/2025 at 11:14 AM the kitchen, the Dietary Supervisor (DS) stated the roof started leaking yesterday on 2/13/2025 around 10 AM and stated the leak was a steady constant drip of water. The staff placed a bucket underneath the area where it was leaking. The kitchen staff informed the maintenance supervisor (MS) and the Administrator (ADM) on 2/13/2025 between 10:30 AM 11:00 AM. The DS stated kitchen was in operation and prepared and served food yesterday and today. The DS further stated there is damaged to the kitchen wall and ceiling in the kitchen and should not have used the kitchen for cooking since it is not a safe environment and potential for infection control. During an observation on 12/14/2025 at 11:21 AM in activity room, the activity room was observed with paint bubbling around an electrical outlet above the entrance to the administrative office on the ceiling. During an interview on 2/14/2025 at 11:23 AM, with Activity Director (AD), the AD stated the roof started leaking yesterday 2/13/2025 around 11 AM, and staff placed a bucket underneath the area that was leaking. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555839 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dreier's Nursing Care Center 1400 West Glenoaks Blvd Glendale, CA 91201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm During an observation on 12/14/2025 at 11:27 AM in the residents shared bathroom, the bathroom was observed with paint bubbling and cracks around the above the toilet area. During an observation on 12/14/2025 at 11:32 AM in Resident 1 room bed C area, the room was observed with paint bubbling on the ceiling in multiple areas around bed C. Residents Affected - Many During a review of the facility document titled maintenance logbook for repair, dated 2/13/2025 indicated, there was a leak in Resident 2 ' s room bed B. During an interview on 2/14/2025 at 11: 52AM, the MS stated he checked the maintenance log yesterday 2/13/2025 around 10 AM and saw a report that there was a leak in Resident 2 ' s room bed B area. The MS stated he placed a plastic tarp outside on the roof. During an interview on 2/14/2025 at 11: 55AM, the MS stated he noticed there was a leak in the kitchen from the ceiling yesterday 2/13/2025 before noon. The MS stated the kitchen ceiling was leaking, and the drywall of the ceiling was damaged from the leak. The MS stated the dry wall was ballooned and swollen and placed a plastic tarp on the roof area. He further stated he did not do anything inside the kitchen since it was the kitchen area was wet. During an interview on 2/14/2025 at 12:01 PM, the MS stated he noticed yesterday on 2/13/2025 sometime around noon that there was a paint bubble and crack in the resident ' s shared bathroom. The MS further stated he placed a plastic tarp on the roof outside. During an interview on 2/14/2025 at 12:04 PM, the MS stated he noticed yesterday 2/13/2025 sometime between 10 AM and 11 AM that there was a paint bubble and crack in Resident 1 ' s room above her bed, Bed C. During an interview on 2/14/2025 at 12:09 PM, the MS stated he noticed yesterday around 10:30 AM there was water leak from the ceiling paint bubbling around an electrical outlet in the activity room and placed a bucket underneath the area. The MS stated he informed administrator about all the leaks at the facility yesterday. The MS stated he did not contact any outside contractor for come to check the roof. During an interview on 2/14/2025 at 12:27 PM with LVN 1, LVN 1 stated yesterday 2/13/2025 around 10 AM LVN 1 noticed the celling in Resident 2 room bed B was leaking in and around the foot of the bed. LVN 1 stated placing some pads on the bed, and documented the information in maintenance log and informed MS. During an interview on 2/14/2025 at 1:28 PM with the DON, the DON stated she was not aware about the leak at facility. The DON stated she was informed this morning around 10 AM that the kitchen was preparing and serving food yesterday and today. During an interview on 2/14/2025 at 2:20 PM with ADM, the ADM stated he was informed about the leak at facility and asked the MS to place plastic tarp on the celling. The ADM stated he did not contact any contractor to evaluate the roof at this time. During an interview on 2/14/2025 at 4:52 PM with ADM, the ADM stated he did not inform the State Agency regarding the leaks at the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555839 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dreier's Nursing Care Center 1400 West Glenoaks Blvd Glendale, CA 91201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete During a review of the facility ' s P&P titled Safety and Supervision of Residents revised 7/2017, indicated the facility strives to make the environment as free from accident hazards as possible and resident safety and supervision and assistance to prevent accidents are facility-wide priorities. The policy indicated resident supervision is a core component of the systems approach to safety. The type and frequency of resident supervision is determined by the individual resident's assessed needs and identified hazards in the environment. The policy indicated due to their complexity and scope, certain resident risk factors and environmental hazards are addressed in dedicated policies and procedures, these risk factors and environmental hazards include the following: bed safety and electrical safety. Event ID: Facility ID: 555839 If continuation sheet Page 6 of 6